Treatment Questions | Pharma Aesthetics

Answer medical questions to order

Have you read the medical information for hair loss treatment?

Yes No

Do you have hair loss in patches, or have an itchy or sore scalp?

Yes No

Irregular patchy hair loss needs investigation.

Do you have sudden unexplained hair loss, or complete hair loss, or hair loss caused by medication?

Yes No

Hair falling out in clumps or over a period of days or weeks needs investigation.

Are you suffering from an illness or skin condition that might explain hair loss?

Yes No

e.g. disease causing weight-loss or fevers e.g. skin conditions such as psoriasis or ringworm (fungal infection)

Are you aware that Propecia tablets / finasteride 1mg are for men only?

Yes No

Propecia/finasteride 1mg will not work in women and may be harmful in pregnancy. Women should not handle crushed or broken tablets.

Are you already taking finasteride for a condition apart from hair loss, or taking dutasteride for prostate enlargement?

Yes No

Finasteride 5mg tablets (Proscar) are sometimes used to treat prostate enlargement.

Are you ordering Regaine/minoxidil 5% and have significant low blood pressure or high blood pressure (even if controlled by tablets), or abnormal heart rhythm, or angina?

Yes No

Only significant if requesting Regaine/minoxidil 5%. If ordering Propecia/finasteride 1mg only please answer 'No'.

If you are over 49 and ordering Regaine extra strength foam, or over 65 and ordering Regaine extra strength solution or minoxidil 5%, do you agree to Regaine extra strength/minoxidil 5% being supplied to you off label (unlicensed)?

Yes No

If ordering Propecia/finasteride only, or under the age limits, answer 'YES' and continue.

Are you aware there have been occasional reports of depression and even suicidal thoughts with Propecia/finasteride?

Yes No

If these occur, stop treatment immediately and consult a doctor.

Although uncommon, are you aware Propecia/finasteride can cause reduced sex drive and/or erection difficulty?

Yes No

These symptoms lead to about 1% of men stopping Propecia/finasteride, and symptoms usually settle down. In extremely rare reports symptoms have persisted. Read patient leaflet for further details.

Are you aware that if hair loss has not reduced after 6 months, treatment should be stopped?

Yes No

Do you have any further medical information or questions?

Yes No

Is there anything you do not understand or do you need further help?

Do the following apply to you?

Yes No

I will report any possible side effects, especially any changes in breast tissue such as lumps, pain, gynaecomastia ('man boobs'), or nipple discharge The medication is for my own use and I will not share with anyone else I will read the patient information leaflet supplied in the medicine pack I am male, over 18, and I agree to identity verification checks I have completed this questionnaire myself and fully understand all the information My responses are honest and accurate, and I understand that this is necessary for a safe medical assessment I agree to the terms & conditions, privacy policy, data sharing policy & consent to cookies

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Hair loss

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